6.S897 | Spring 2019 | Graduate

Machine Learning for Healthcare

Readings

Ses # Required Readings Optional Readings
1 No required readings. Bates, David, Suchi Saria, et al. “Big Data In Health Care: Using Analytics to Identify and Manage High-Risk and High-Cost Patients.Health Affairs 33, no. 7 (July 2014): 1123–31.
2 No required readings. No readings.
3 Agniel, Denis, Isaac Kohane, and Griffin Weber. “Biases in Electronic Health Record Data Due to Processes Within the Healthcare System: Retrospective Observational Study.BMJ, 2018. No readings.
4

Razavian, Narges, Saul Blecker, et al. “Population-Level Prediction of Type 2 Diabetes From Claims Data and Analysis of Risk Factors.Big Data 3, no. 4 (2015): 277–87.

Pozen, Michael, Ralph D’Agostino, et al. “A Predictive Instrument to Improve Coronary-Care-Unit Admission Practices in Acute Ischemic Heart Disease.New England Journal of Medicine 310, no. 20 (1984): 1273–78.

No readings.
5

Futoma, Joseph, Sanjay Hariharan, et al. “An Improved Multi-Output Gaussian Process RNN With Real-Time Validation for Early Sepsis Detection.arXiv preprint arXiv:1708.05894 (2017).

Caruana, Rich, Yin Lou, et al. “Intelligible Models for HealthCare.Proceedings of the 21th ACM SIGKDD International Conference on Knowledge Discovery and Data Mining - KDD 15, 2015.

Henry, Katharine, David Hager, et al. “A Targeted Real-Time Early Warning Score (TREWScore) for Septic Shock.Science Translational Medicine 7, no. 299 (May 2015).

Rodríguez, G. (2007). “Chapter 7: Survival Models.” In Lecture Notes on Generalized Linear Models.

6

Quinn, J.A., C.K.I. Williams, and N. Mcintosh. “Factorial Switching Linear Dynamical Systems Applied to Physiological Condition Monitoring.IEEE Transactions on Pattern Analysis and Machine Intelligence 31, no. 9 (2009): 1537–51.

Hannun, Awni, Pranav Rajpurkar, et al. “Cardiologist-Level Arrhythmia Detection and Classification in Ambulatory Electrocardiograms Using a Deep Neural Network.Nature Medicine 25, no. 3 (2019): 65–69.

No readings.
7 Leaman, Robert, Ritu Khare, and Zhiyong Lu. “Challenges in Clinical Natural Language Processing for Automated Disorder Normalization.Journal of Biomedical Informatics 57 (2015): 28–37.

Halpern, Yoni, Steven Horng, et al. “Electronic Medical Record Phenotyping Using the Anchor and Learn Framework.Journal of the American Medical Informatics Association 23, no. 4 (2016): 731–40.

Elhadad, N., and D. Demner-Fushman. “Aspiring to Unintended Consequences of Natural Language Processing: A Review of Recent Developments in Clinical and Consumer-Generated Text Processing.Yearbook of Medical Informatics 25, no. 01 (2016): 224–33.

8 No required readings.

Vaswani, Ashish, Noam Shazeer, et al. “Attention Is All You Need.” In Advances in Neural Information Processing Systems, pp. 5998-6008. 2017.

Devlin, Jacob, Ming-Wei Chang, et al. “Bert: Pre-Training of Deep Bidirectional Transformers for Language Understanding.arXiv preprint arXiv:1810.04805 (2018).

9 No required readings.

Fihn, Stephan, Joseph Francis, et al. “Insights From Advanced Analytics at the Veterans Health Administration.Health Affairs 33, no. 7 (2014): 1203–11.

Amland, Robert C., and Kristin E. Hahn-Cover. “Clinical Decision Support for Early Recognition of Sepsis.American Journal of Medical Quality 31, no. 2 (March 2016): 103–10.

10 Ranschaert, Erik, Sergey Morozov, and Paul Algra. “Chapter 13: Artificial Intelligence and Computer-Assisted Evaluation of Chest Pathology.” In Artificial Intelligence in Medical Imaging: Opportunities, Applications and Risks. Cham, Switzerland: Springer, 2019. ISBN: 9783319948775.

Zhang, Jeffrey, Sravani Gajjala, et al. “Fully Automated Echocardiogram Interpretation in Clinical Practice: Feasibility and Diagnostic Accuracy.Circulation 138, no. 16 (2018): 1623-1635.

Lieman-Sifry, Jesse, Matthieu Le, et al. “FastVentricle: Cardiac Segmentation with ENet.Functional Imaging and Modelling of the Heart Lecture Notes in Computer Science (2017): 127–38.

11 Rotmensch, Maya, Yoni Halpern, et al. “Learning a Health Knowledge Graph from Electronic Medical Records.Scientific Reports 7, no. 1 (2017): 5994. 

Shwe, M. A., D. E. Heckerman, et al. “Probabilistic Diagnosis Using a Reformulation of the INTERNIST-1/QMR Knowledge Base.Methods of Information in Medicine 30, no. 04 (1991): 241–55.

Pople, H. E., Jr. “Heuristic Methods for Imposing Structure on Ill-Structured Problems: The Structuring of Medical Diagnostics.” In Szolovits, P. (Ed.) Artificial Intelligence in Medicine. 1982.

12 Wang, Dayong, Aditya Khosla, et al. “Deep Learning for Identifying Metastatic Breast Cancer.arXiv preprint arXiv:1606.05718 (2016). Oakden-Rayner, Luke. “Exploring the ChestXray14 Dataset: Problems.” Rayner, December 18, 2017.
13 Ranschaert, Erik, Sergey Morozov, and Paul Algra. “Chapter 14: Deep Learning in Breast Cancer Screening.” In Artificial Intelligence in Medical Imaging: Opportunities, Applications and Risks. Cham, Switzerland: Springer, 2019. ISBN: 9783319948775. Lehman, Constance, Adam Yala, et al. “Mammographic Breast Density Assessment Using Deep Learning: Clinical Implementation.Radiology 290, no. 1 (2019): 52–58.
14 Hernán MA, Robins JM. Causal Inference: What If. Boca Raton: Chapman & Hall/CRC, forthcoming. Chapter 1. 2019.

Brat, Gabriel, Denis Agniel, et al. “Postsurgical Prescriptions for Opioid Naive Patients and Association with Overdose and Misuse: Retrospective Cohort Study.BMJ, 2018.

Bertsimas, Dimitris, Nathan Kallus, et al. “Personalized Diabetes Management Using Electronic Medical Records.Diabetes Care 40, no. 2 (Feb 2017): 210–17. 

Huszar, Ferenc. “Causal Inference 3: Counterfactuals.” inFERENCe. January 24, 2019.

15 No required readings.

Rosenbaum, Paul R. “From Association to Causation in Observational Studies: The Role of Tests of Strongly Ignorable Treatment Assignment.Journal of the American Statistical Association 79, no. 385 (1984): 41.

Kallus, Nathan, and Angela Zhou. “Confounding-Robust Policy Improvement.” In Advances in Neural Information Processing Systems, pp. 9269-9279. 2018.

Louizos, Christos, Uri Shalit, et al “Causal Effect Inference with Deep Latent-Variable Models.” In Advances in Neural Information Processing Systems, pp. 6446-6456. 2017.

16 Prasad, Niranjani, Li-Fang Cheng, et al. “A Reinforcement Learning Approach to Weaning of Mechanical Ventilation in Intensive Care Units.arXiv preprint arXiv:1704.06300 (2017).

Chakraborty, Bibhas, and Erica Moodie. Statistical Methods for Dynamic Treatment Regimes. Section 2.1, 2.2, and Chapter 3. Springer, 2013. ISBN: 9781461474272.

Gottesman, Omer, Fredrik Johansson, et al. “Guidelines for Reinforcement Learning in Healthcare.Nature Medicine 25, no. 1 (2019): 16–18.

17 Komorowski, Matthieu, Leo Celi, et al. “The Artificial Intelligence Clinician learns optimal treatment strategies for sepsis in intensive care.Nature Medicine 24, no. 11 (2018): 1716.

Does the ‘Artificial Intelligence Clinician’ Learn Optimal Treatment Strategies for Sepsis in Intensive Care?” point85.

Dickerman, Barbra, Edward Giovannucci, et al. “Guideline-Based Physical Activity and Survival Among US Men With Nonmetastatic Prostate Cancer.American Journal of Epidemiology 188, no. 3 (2018): 579–86.

18 Schulam, Peter, and Suchi Saria. “Integrative Analysis Using Coupled Latent Variable Models for Individualizing Prognoses.The Journal of Machine Learning Research 17, no. 232 (2016): 1–35. No readings.
19 Young, Alexandra, Razvan Marinescu, et al. “Uncovering the Heterogeneity and Temporal Complexity of Neurodegenerative Diseases with Subtype and Stage Inference.Nature Communications 9, no. 1 (2018): 4273.

Wang, Xiang, David Sontag, and Fei Wang. “Unsupervised Learning of Disease Progression Models.” In Proceedings of the 20th ACM SIGKDD international conference on Knowledge discovery and data mining, pp. 85-94. ACM, 2014.

Pierson, Emma, Pang Wei Koh, et al. “Inferring Multi-Dimensional Rates of Aging from Cross-Sectional Data.arXiv preprint arXiv:1807.04709 (2018).

Saelens, Wouter, Robrecht Cannoodt, et al. “A Comparison of Single-Cell Trajectory Inference Methods.Nature Biotechnology 37, no. 5 (2019): 547–54.

Campbell, Kieran R., and Christopher Yau. “Order Under Uncertainty: Robust Differential Expression Analysis Using Probabilistic Models for Pseudotime Inference.PLOS Computational Biology 12, no. 11 (2016).

20 Udler, Miriam S., Jaegil Kim, et al. “Type 2 Diabetes Genetic Loci Informed by Multi-Trait Associations Point to Disease Mechanisms and Subtypes: A Soft Clustering Analysis.PLoS Medicine 15, no. 9 (2018): e1002654. Denny, Joshua, Marylyn Ritchie, et al. “PheWAS: Demonstrating the Feasibility of a Phenome-Wide Scan to Discover Gene–Disease Associations.Bioinformatics 26, no. 9 (2010): 1205-1210.
21 No required readings.

Zhang, Yiye, Rema Padman, and Nirav Patel. “Paving the COWpath: Learning and Visualizing Clinical Pathways from Electronic Health Record Data.Journal of Biomedical Informatics 58 (2015): 186–97.

Gawande, Atul. “A Life-Saving Checklist.The New Yorker. The New Yorker, December 3, 2007.

22 US Food and Drug Administration. “Proposed Regulatory Framework for Modifications to Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device (SaMD)-Discussion Paper and Request for Feedback.” (2019).

Coravos, Andy. “The Doctor Prescribes Video Games and Virtual Reality Rehab.Wired. Conde Nast, November 20, 2018.

Coravos, Andy, Irene Chen, et al. “We Should Treat Algorithms like Prescription Drugs.Quartz. Quartz, February 19, 2019.

Want to Create Meaningful Change in the US Healthcare System? Serve a ‘Tour of Duty’ in the Government.Rock Health. March 25, 2019.

Hsiang, Mina. “If You Want to Make Government Programs Work Better, Submit a Public Comment.Medium. Medium, March 23, 2019.

23–25 No required readings. No readings.

Session 3 Reading Questions

  • What are some of the challenges of using retrospective data from electronic health records?
  • The paper states that “the presence of a white blood cell count test order is associated with a 2.1% lower survival rate (P<0.001).” What does the P<0.001 signify?
  • All else equal, would we expect the survival rate to be higher for a patient with a 5pm white blood test or a 5am white blood test?
  • All else equal, would we expect the survival rate to be higher for a patient with a Sunday white blood test or a Wednesday white blood test?
  • Besides time of lab test and the lab test value, what other healthcare process variables might give additional signal for prediction of 3-year survival?

Session 4 Reading Questions

  • [Razavian et al, 2015] The trained model used in this paper might not identify high risk patients well for a rural hospital in Wyoming. Name two potential reasons why.
  • [Razavian et al, 2015] In Figure 1, we see that Patient G is excluded because they experienced diabetes onset during the gap period. Why is there a gap period for this prediction task?
  • [Pozen et al, 1984] Based on the paper’s results, name three ways we would expect the CCU to change if we rolled out the model completely and physicians followed the model’s recommendations.

Session 5 Reading Questions

  • [Caruana et al.] What are the different approaches that the authors suggest for interpreting the results from learning with few versus very many features, and why are the different approaches needed?
  • [Caruana et al.] What utility does introducing a bias term serve in terms of improving the interpretability of the learned model?
  • [Futoma et al.] Before their “real-time validation” experiment, how do they decide how much data to consider for a negative example (i.e. one who never develops sepsis)?

Session 6 Reading Questions

  • [Quinn et al, 2009] What problem is the factorial model trying to solve that the SLDS model struggles with?
  • [Hannun et al, 2016] How does the performance of the DNN compare to the aggregated cardiologist score? How do the mistakes made by the DNN compare to those made by the cardiologists?

Session 7 Reading Questions

  • [Leaman et al, 2015] What makes identifying disorder mentions in clinical text difficult?

Session 10 Reading Questions

  • What is Echocardiography?
  • What is one reason why a doctor might want a VNAP to provide versioning?

Session 11 Reading Questions

  • What are the three models that the authors compare to build a health knowledge graph? (Give names of models, no need to elaborate.)
  • How are diseases and symptoms extracted from the clinical records?
  • Which symptom did the authors omit from the analysis?

Session 12 Reading Questions

  • What are patches and how are they used in the model outlined by the authors?
  • How did the authors incorporate a clinician into the pipeline?

Session 13 Reading Questions

  • What are sensitivity and specificity? Overall how do CAD systems and double-readings compare on sensitivity and specificity?
  • What are two challenges from using patch-centered methodologies?
  • What is tomosynthesis and how does it compare to traditional mammography?

Session 14 Reading Questions

  • Examine Table 1.1. Assume our universe only includes gods whose names begin with “H”. This leaves us with 6 gods. What is P(Y^(a=0) = 1 | “H” gods)? What is P(Y^(a=1) = 1 | “H” gods)?
  • Examine Table 1.2. Assume our universe only includes gods whose names begin with “H”. This leaves us with 6 gods. What is P(Y=1 | A=0, “H” gods)? What is P(Y=1 | A=1, “H” gods)?
  • Explain “confounding” in 15 words or less. Does not have to be a complete sentence.

Session 16 Reading Questions

  • The authors seek to model mechanical ventilation in the ICU as a off-policy reinforcement learning algorithm. What is the action space? What is the reward space? (Short answers okay!)
  • What is the main difference between on-policy and off-policy reinforcement learning? (can be short!) Why do the authors choose to use off-policy learning here?
  • Figure 6 shows the learned feature importance. Pick one value and explain whether or not it makes sense to be a high/low weight.

Session 17 Reading Questions

  • One difference between Komorowski et al 2018 and Prasad et al 2017 is the difference in reward function. What is the reward function here?
  • Name two limitations of the study.

Session 22 Reading Questions

  • Draft a paragraph on component or concepts in the white paper that the agency should:
    1. Keep in future iterations
    2. Remove or clarify in future iterations
    3. Add (for missing components)Suggestions: consider topics covered in previous lectures including generalizability, evaluation, updating models, fairness, causality, etc.
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